CTICasesOrganizing Pneumonia
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Imaging findings
CT scan showed areas of consolidation with associated ground glass opacity, some with lobular sparing or more severely affected secondary pulmonary lobule margins. The consolidation was bronchovascular predominant, with axial distribution giving the appearance of subpleural sparing. Follow-up after corticosteroid treatment showed decreased density and extent of consolidation and ground glass opacity, with persistent perilobular opacity appearing as apparent sparing of the central aspect of secondary pulmonary lobules and involvement of margins. Residual architectural distortion was noted.
Key takeaways
Organizing pneumonia is typically very sensitive to steroids, showing significant improvement, though some patients may be left with focal scarring. The perilobular pattern of fibrosis, especially in less severely affected areas, may suggest causes of pulmonary fibrosis other than idiopathic pulmonary fibrosis (IPF/UIP). This case demonstrates the natural evolution of organizing pneumonia and its response to treatment, with discussion on its potential progression to fibrotic lung disease like NSIP. The cause in this patient was not definitively identified, but possible aspiration secondary to bronchiectasis was considered.
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